Tic-Related OCD

What does tic-related OCD mean?

Tic-related OCD is a specifier applied to an OCD diagnosis when the person has, or has previously had, a tic disorder. It does not specify the theme of the OCD. Two people with tic-related OCD may therefore have very different obsessions, compulsions and tics.

A tic is a sudden, rapid and recurring movement or sound. Motor tics may include blinking, facial movements, head jerks or movements of the shoulders and hands. Vocal tics may include throat clearing, sniffing, small sounds, words or more complex utterances. Many people experience a bodily urge or tension that is briefly relieved when the tic occurs.

In OCD, the preceding experience may be an intrusive thought, an image, doubt, a sense of responsibility, bodily discomfort or a feeling that something is wrong or incomplete. Thoughts, analyses and visible or mental actions may become attempts to create certainty or obtain relief. A compulsion may resemble a complex tic when it is driven by a sensory feeling that something is wrong rather than by fear of a particular catastrophe.

Tapping a table three times may be a motor tic, a compulsion or a mixed action. The bodily urge, thoughts, rules and experience before and after the movement are more informative than its appearance alone.

Tics and compulsions are not the same

A tic often follows a bodily urge. The person may notice tension, itching, pressure or a feeling that the movement has to come out. The tic provides brief physical relief. Many people can suppress it for a time, but this requires concentration, and the urge may grow in the meantime.

A compulsion is typically performed in response to an obsession, doubt or an OCD-driven experience. The person may fear that something dangerous will happen if the action is not performed, or try to create symmetry, certainty or correctness. The action may be visible or mental and often follows a rule.

For some, the distinction becomes blurred. Tics may be complex, repeated in particular patterns and surrounded by rules. Compulsions may be rapid and driven by a bodily sense of incompleteness without a clearly worded thought. A person may begin with a tic and then repeat it until it feels right. A tic may also prompt OCD doubt about whether the movement was symmetrical or could have harmed someone.

The same visible movement may have a different function at different times. A movement that first relieves a bodily urge may later be repeated according to a rule or to obtain a particular sensation.

Tic-related OCD in children and young people

Tics typically begin in childhood. They may wax and wane over time, with new tics appearing while others disappear. OCD symptoms may begin at the same time as the tics or later.

At school, a child may use a great deal of energy suppressing tics. The tics are often more visible at home, where the child no longer has to spend energy trying to conceal them. After a school day, the child may therefore be exhausted or irritable. If Just-Right rituals are also present, homework, handwriting, dressing or transitions may take a long time.

People around the child may find themselves correcting movements and sounds that the child does not fully control. They may also begin helping with extensive rituals for fear of putting the child under pressure. The child is not being naughty when a tic occurs. Rules may change when OCD tries to make an action feel right. Accepting tics is different from taking part in OCD rituals.

Some children with tics or Tourette syndrome also have ADHD, autism or anxiety. This may, among other things, make it harder to maintain focus, manage sensory input and handle changes and demands in daily life.

When tics become the theme of OCD

A person may have OCD about the tics themselves. Doubt may concern whether a tic was voluntary, aggressive, sexual or socially inappropriate. The person investigates whether they wanted the movement and uses their bodily reaction as evidence. Here, analysis of the tic becomes part of OCD; the tic itself may still be a response to a bodily urge.

Fears about responsibility may also arise. The person avoids holding a baby because a sudden jerk could cause harm, or keeps their distance from others on public transport. OCD may turn a specific precaution into a demand for absolute control over the body.

Comments from others may lead the person to continually monitor their facial expressions, sounds and movements. The subsequent analysis of the tic’s meaning may occupy more of the person’s attention than the movement itself and become an independent OCD pattern.

When a brief tic becomes a lengthy OCD sequence

A tic may be over in seconds while the OCD pattern around it continues. The person may begin monitoring the body before particular situations, correct or even up the movement when it occurs and afterwards reconstruct their intention, the distance involved and other people’s reactions. The tic itself is brief, but the monitoring, corrections and subsequent analysis may last a long time.

Before the tic, the person may hold their arms stiffly, keep extra distance from others or monitor the bodily urge. This monitoring is intended to prevent a later tic from prompting doubt about harm, boundaries or social behaviour.

Around the tic, the movement may be repeated on the other side, performed with a particular force or corrected until the body feels symmetrical. The first movement provides brief relief from the bodily urge, while subsequent movements follow an OCD rule.

After the tic, the person may review the movement, read other people’s expressions, recall the precise distance or ask whether anyone noticed something. The analysis is intended to determine whether the tic was voluntary, dangerous or revealed a hidden intention.

In the three-part functional model of OCD, monitoring before the tic may serve a proactive function, correction around the tic a reactive function and reconstruction afterwards a retrospective function. A brief movement may thereby be surrounded by compulsions before, during and after it.

Can tic-related OCD involve other OCD themes?

Tic-related OCD describes the person’s history of tics, not the content of the obsessions. OCD may concern harm, contamination, illness, morality or relationships, for example. For others, sensory incompleteness, symmetry and complex repetitions are more prominent.

Tourette syndrome is a tic disorder involving both motor and vocal tics. When OCD occurs in a person with a current or previous tic disorder, the tic-related OCD specifier is used. Tourettic OCD describes the narrower overlap pattern in which tics, bodily urges and compulsive rules are closely interwoven.